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February 15, 2014

"Healthcare Not Handcuffs": Will ACA help end the drug war?

The title and question of this post is my take on this notable recent report from the ACLU and the Drug Policy Alliance titled "Healthcare Not Handcuffs: Putting the Affordable Care Act to Work for Criminal Justice and Drug Policy Reform." Here is an excerpt from the report's introduction:

The Affordable Care Act (ACA) is the most significant expansion of healthcare coverage in generations, and there is almost no area of the U.S. healthcare system that is not impacted by the reform in some way. Even as debate about the ACA continues, it is now the law of the land, and implementation is fully under way. For criminal justice reform and drug policy reform advocates, the ACA represents a remarkable opportunity to advance efforts to end both mass incarceration and the criminalization-based approach to drug policy often known as the War on Drugs.

Under the ACA, tens of millions of people in the United States will gain healthcare coverage for a broad array of health services and conditions, including, for the first time, substance use and mental health disorders. Of course, there are also problems with the ACA and its implementation, not the least of which is that millions of people will remain uninsured even after the law is fully operational. Yet even with these challenges, the ACA sets the stage for a new health-oriented policy framework to address substance use and mental health disorders -- health problems that have been largely relegated to the criminal justice system for more than 40 years.

This is an enormous paradigm shift that has yet to fully register with criminal justice and drug policy reform advocates, let alone with health policy advocates and the general public. The financial benefits of providing substance use disorder treatment instead of incarceration are well established. But by fully incorporating substance use and mental health disorders into healthcare -- by truly treating them as health issues and requiring public and private insurance plans to cover their treatment -- the ACA creates an opening and financial incentives to shift drug policy into a public health framework, undermining the rationale for a criminal justice approach....

The passage and implementation of the ACA coincides with the growing momentum across the political spectrum to end the War on Drugs, reverse the incarceration boom, and abandon criminal justice policies that have resulted in the criminalization of whole communities. But the paradigmatic shift from criminalization to health will not occur unless criminal justice and drug policy reform advocates seize the moment and leverage the ACA to realize its full transformative potential.

To assist advocates in navigating this new terrain, this paper outlines some of the major provisions of the ACA immediately relevant to criminal justice and drug policy reform (Part One), and then explores specific applications of those provisions, including program and policy examples and suggested action steps (Part Two)....

This is a unique, perhaps even once-in-a-lifetime scenario for criminal justice and drug policy reform advocates: with the ACA, we can start to build true alternatives to the criminal justice response to substance use, the enforcement of which has fundamentally undermined community health and safety. Addressing substance use as a health condition has the potential to lower health costs, dramatically reduce the number of people involved in the criminal justice system, and improve health outcomes and overall wellbeing for millions of people.

Comments

Ah, no. The family breakdown adds more demand for drugs, which intensifies either the wars among the cartels of the illegal trade, or to the overall detriment of individuals whom don't learn self-responsibility for their actions and partake of legal drugs. Either way, criminal acts will intensify.

Note this answer is a direct analysis of known facts, not an opinion on the efficacy of the drug laws as a constitutional right.

Posted by: Eric Knight | Feb 15, 2014 4:40:04 PM

People don't get high because they have a mental defect. They get high because they like the feeling of being high.

Posted by: Bill Otis | Feb 15, 2014 8:23:39 PM

People don't get to be Bill Otis because they like the feeling of being Bill Otis. They get to be Bill Otis because they have a mental defect.

Posted by: Daniel | Feb 15, 2014 10:35:38 PM

Daniel --

OK, I'll bite. What's the defect? Not buying everything Eric Holder says? Favoring the death penalty? Thinking that people plead guilty because they are in fact guilty? Believing that judges shouldn't have 100% sentencing discretion 100% of the time?

What?

BTW, do you disagree that people get high because they like the feeling of being high?

Posted by: Bill Otis | Feb 15, 2014 10:43:23 PM

Bill.

My prior comment was an attempt to highlight the fact your initial comment was facile. Of course people get high because they like the feeling of being high...among at least a dozen different reasons... one of which is that people do get high because they have a mental defect or disease. Self-medication for depression, anxieties, and other psychological disorders is well established in the literature. That's not an excuse, just a fact.

"facile.(esp. of a theory or argument) appearing neat and comprehensive only by ignoring the true complexities of an issue."

You do not serve your cause Bill by making facile arguments...especially when I know that you know better.

Posted by: Daniel | Feb 16, 2014 2:53:39 AM

Facile. Good word for Bill's take on human frailty. It now joins other words that typically leap to mind whenever Bill holds forth on criminal justice issues: smug, sanctimonious, scold, callous,

Posted by: John K | Feb 16, 2014 8:23:54 AM

Erik and Daniel: I am disappointed, and condemn your personal remarks about Bill. You do not get to do that until you have posted a couple of comments promoting the interests of crime victims. Bill is the only lawyer here who has done so. I am not saying to shut up, just that you both sound immature, and frustrated in the traverse, by your personal attack. Those attacks are the same as knocking over your King in a hopeless position in a chess match.

He has called me unhinged, but for me, that is funny. He does not like my terms of art, lawyer dumbass, or vile feminist lawyer and its male running dogs. They are not epithets, however, just accurate terms of art.

You do not get to comment on others until you have disclosed your own economic interests. One imagines, a shift of funding to mental treatments would represent a windfall. Even if not involved in prisoner treatment, such an approach will suck up the time of your competitors and cause an increase in your fees. I am alleging economic conflict of interest until you can rebut that.

I am speaking for myself and not for Bill. However, no one is in prison for self medication, but for car jacking, murder of competitors, and for selling huge amounts of illegal drugs to an undercover police. So drug courts are just adding addiction to the long list of whacked lawyer mitigating factors, finding any pretext to coddle heartless, vicious predators. Why? To generate massive make work jobs for the lawyer profession. It is another lawyer bunko scheme. Victims generate nothing and may rot.

The stronger the methodology of a study, the smaller the effect of drug courts on recidivism.

I advocate 123D. The deceased have zero recidivism. Of course, they do not generate lawyer fees, either. So crime will not end until the lawyer is removed from all policy positions, including all benches.

Any study cannot exclude officially violent offenders or it does not even apply to non-violent offenders. Theymay be ultra-violent but pled to a non-violent offense.

In measurement of recidivism, arrests records are worthless, since most crimes do not result in an arrest. One must have a certificate from the DOJ allowing the interviewee absolute immunity for reporting a crime he committed. Then recidivism must be assessed by subject interview. Records may show a low rate. Interviews may reveal hundreds of crimes a year by an individual.

At a common sense level. Compare the pleasures of addictions, including to sexual offenses. To the low risk of arrest. Not much of a contest.

"Under the ACA, tens of millions of people in the United States will gain healthcare coverage for a broad array of health services and conditions, including, for the first time, substance use and mental health disorders."

One of a few ways that the Obama Administration is helping to deal with the drug problem in this country in ways other than locking people up. It is worthy of criticism that they don't do enough, but it's good to note the Administration is doing more than not pardoning people and the like.

More good news until the Rpublicans cheapen it to where it becomes worthless.
FOR IMMEDIATE RELEASE
September 6, 2013

Contact: HHS Press Office
(202) 690-6343

HHS announces expansion of Maternal, Infant, and Early Childhood Home Visiting
Health and Human Services (HHS) Secretary Kathleen Sebelius today announced $69.7 million in grant awards to 13 states to expand Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program activities funded by the Affordable Care Act. These competitive awards recognize states that have implemented a high-quality, evidence-based home visiting program as part of a comprehensive, early childhood system of care.

“These awards support states in their efforts to expand and improve home visiting support services for our most vulnerable children and families,” said Secretary Sebelius.

Funded by the Health Resources and Services Administration (HRSA), the MIECHV Program provides grants to states to deliver critical health, development, early learning and family support services to children and families who enroll in the program. The program provides voluntary home visits in communities identified by the state grantees for eligible families who welcome education and support to strengthen their relationship with their infants and young children. The program helps to ensure women have a healthy pregnancy.

Since the MIECHV Program was enacted in 2010, it’s been implemented in 544 communities in all 50 states, the District of Columbia, and five territories to serve about 15,000 families. HHS’ Administration for Children and Families (ACF) partners with HRSA to implement the MIECHV Program, and leads the Tribal Home Visiting Program.

“This program plays a crucial role in the national effort to build comprehensive statewide early childhood systems for pregnant women, parents and caregivers, and children from birth to 8 years of age – and, ultimately, to improve health and development outcomes,” said Mary Wakefield, Ph.D., R.N., Administrator, HRSA.

http://www.hhs.gov/news/press/2013pres/09/20130906a.html

Compare $69.7 million to the punishment budget though.

Posted by: George | Feb 16, 2014 2:50:35 PM

George --

Didn't you get Doug's memo? We're supposed to be for SMALLER government.

Posted by: Bill Otis | Feb 16, 2014 3:18:41 PM

Daniel --

"facile.(esp. of a theory or argument) appearing neat and comprehensive only by ignoring the true complexities of an issue."

Let's try this: "sophistic. (esp. of a theory or argument) appearing complex and convoluted only be ignoring the central reality of an issue."

If you want to know whether the use of illegal drugs is caused by the need to, in the words of the hilarious phrase, "self medicate," go to any Saturday night high school or frat party and see, in addition to the beer chugging, how much druggie "medication" is going on. Hint: It's not "medication." It's getting blasted. Are you really missing what every 19 year-old knows?

P.S. As you more than others should know, depression and anxiety are emotional conditions, not "mental defects." And as I know more than (apparently) you do, people do not knock over the 7-11 EITHER because they're depressed and anxious, OR because they have a mental defect. They knock it over because they're greedy, think they're tough, and that normal jobs are for jerks and rules are for suckers.

"So once again, the nursing program for at risk mothers (who have at risk children) seems to be the solution. As an added benefit, less prisons need be built and so less people like TarlsQtr1 would be required to "teach" the inmates. Here is a study that may explain why the program works and it appears to amount to "I have a friend that happens to be an expert in child health, so I can trust myself more." Or maybe The Militarizing of Local Police (Forbes)is the more manly solution."

I didn't really have an opinion on the ACA until now. It will shrink the government, especially the punishment side. To me the most valuable enlightenment of this blog is the obvious truth the conservatives LIKE punishment. It is their "drug of choice" and they therefore ignore or put down other more promising options. All one needs to do to confirm this is check out their posting history.

'Distrust all in whom the impulse to punish is powerful.' -- Nietzsche.

Posted by: George | Feb 16, 2014 3:57:46 PM

George --

"I didn't really have an opinion on the ACA until now. It will shrink the government, especially the punishment side."

George, I'm just going to let that speak for itself. But it will be fair rebuttal from now on when one of your allies cites you for something. My reply will be, "Ummmm, isn't George the same guy who thinks Obamacare will shrink the government?"

P.S. "Distrust all in whom the urge to spend other people's money is strong."

Posted by: Bill Otis | Feb 16, 2014 4:05:52 PM

John K --

I hardly condemn human frailty, having a good deal of it myself. But I don't indulge it either, and I certainly don't mistake it (as you do) for brutality, malevolence, greed and dishonesty, those (not frailty) being the principal hallmarks of the criminals before whom you genuflect.

Words that typically leap to mind whenever you hold forth on crime victims: smug, sanctimonious, cold, callous. "Dismissive" would probably be the most apt, however.

Posted by: Bill Otis | Feb 16, 2014 4:14:42 PM

Mr Bill: "Ummmm, isn't George the same guy who thinks Obamacare will shrink the government?"

Yes, thank you very much.

The nursing program saves 3 dollars for every dollar spent, much of that in law enforcement costs, including prisons. I have already cited the sources -- ignored. 1 dollar is less than 3 dollars, so that is smaller. A smaller government is a shrinkage.

Speaking of money. Why do you want to spend 3 times the money? So we should distrust you because you like punishment so much AND because you want to spend more of everyone's money. The corollary is that you prefer more victims because before prison there must be a victim.

Posted by: George | Feb 16, 2014 4:18:42 PM

George --

I repeat: If you actually want to believe that Obamacare will shrink the size of government, have at it.

But I'll ask some questions you might want to look into, understanding that Obamacare was signed into law almost four years ago (March 23, 2010).

Is the federal government bigger or smaller now than it was then?

Is the federal debt bigger or smaller now that it was then?

Is spending on heath care bigger or smaller now than it was then?

Are those things, or any one of them, projected BY ANYONE to be bigger or smaller in five years than they are now? In ten years?

George stated: "I didn't really have an opinion on the ACA until now. It will shrink the government, especially the punishment side."

Thank you for the single dumbest comment on this blog ever, or at least since last week.

Posted by: TarlsQtr | Feb 17, 2014 12:58:02 PM

TarlsQtr --

LOL. You can almost hear the liberals scampering for the hills on that one. They have no great trouble calling the opposition racist, etc., etc., but head for the cone of silence when one of their number aggressively claims something that is not merely false, but absurd.

You would hope some liberal here would tell George, "C'mon, man, give it a rest with this 'Obamacare-creates-small-government stuff,'" but it never seems to happen.